Abundant research indicates that healthcare delivery systems built around a strong foundation of primary care achieve higher quality of care, superior outcomes, and lower costs. However, due to poor reimbursement and compressed office visits, primary care is viewed as an unattractive career choice by young clinicians, which has led to a shortage of primary care providers in the US. This shortage will only worsen as provisions of the Affordable Care Act that expand access are implemented. In response to these challenges, the patient- centered medical home (PCMH) has emerged as a promising new vehicle for revitalizing primary care and for delivering comprehensive, patient-centered, cost-effective care. Notably, several studies of early adopters of the PCMH model found reductions in hospitalizations, emergency room use, and costs and improvements in quality of care and provider satisfaction These early findings have spawned new initiatives to implement the PCMH model by private insurers, professional societies, integrated healthcare systems, and federal and state healthcare programs, including the Veterans Health Administration, which in 2010 launched the nation's largest PCMH initiative, to date. Because these newer initiatives are targeting a broader spectrum of practices, evidence about the impact of the PCMH model and the barriers to implementation in these settings will be particularly valuable in informing future PCMH implementation. It is in this context that the Society of General Internal Medicine (SGIM), Society of Teachers of Family Medicine (STFM), and the Academic Pediatric Association (APA) propose a national invited conference to develop a research agenda to inform further adoption of the PCMH and disseminate preliminary results from ongoing initiatives. These three organizations hosted an initial agenda-setting conference on the PCMH in 2009. However, broader adoption of the PCMH raises new questions and issues regarding the dissemination, implementation, and sustainability of the PCMH model. The conference will convene researchers, representatives of key primary care professional organizations, health care purchasers, payers, patient advocates, and policy makers committed to the PCMH model. The five goals of the conference are to: 1) Review emerging evidence about the impact of the PCMH model on quality, access, and costs of care, including patient and family-centered measures of care. 2) Identify organizational and professional barriers in introducing specific elements of the PCMH model and transforming practices. 3) Examine payment models that have been proposed to support PCMH implementation and the practice investments and resources required for successful PCMH implementation. 4) Identify emerging trends and issues that are likely to impact PCMH implementation. 5) Examine the impact of the PCMH implementation on healthcare disparities. 1

Public Health Relevance

The goal of this grant is to convene a national invited conference to develop a research agenda that will support initiatives to implement the patient centered medical home (PCMH) model in primary care practices caring for adults and children. The conference will bring together a number important stakeholders, including primary care practitioners, researchers, health care purchasers, payers, patient advocates, and policy makers, and will review evidence about the impact of the PCMH model on quality, access, and costs of care, barriers to implementing the PCMH model in different types of practices, possible payment models for the PCMH, and the impact of the PCMH on racial and ethnic disparities in healthcare delivery. The conference will be sponsored by three major organizations - the Society of General Internal Medicine (SGIM), Society of Teachers of Family Medicine (STFM), and the Academic Pediatric Association (APA) - that are at the forefront of efforts to improve the delivery of primary care in the US. 1